Sunil J Wimalawansa Professor of Medicine, Endocrinology, & Nutrition, USA

Dear friends:

Since I haven’t seen any medical society from Sri Lanka providing safe practices and guidelines for avoiding COVID-19, I thought of sending this in a summarized form.  I hope these and the links provided at the end of this email will be useful and save lives.

It is time that everyone takes personal responsibility and actions needed seriously, rather than waiting for the government to take care of yourselves.  The latter will not be materialized.  This includes but not limited to engaging in right personal hygiene (no short cuts please), keeping the distance of 6 feet or more between people, avoiding crowded places, frequent hand sanitation, minimize travel, wearing face masks when going out, and other essential hygienic maneuvers.

One must take extreme precautions to safeguard yourself and others.  You never know who is infected, until it is too late.  So, eat healthily and stay at home and be safe.  Thus, unless you invite a person for a specific purpose, there is no reason at all for anyone to come inside your home: It’s your home, your privacy, and your family’s safety.  

Until proven otherwise, assume that he/she is bringing the COVID-19 virus with them.  If anyone insists that they want to talk to you, speak to them outside your home (you do not even need to go out), but wearing a face mask.  Don’t be afraid to refuse entrance to strangers, including any official: Why taking unnecessary risk.  It is the right thing to do to safeguard you and the family.

All healthcare workers and others working in the frontlines are most vulnerable: they must be provided with effective face masks by the government and should take the utmost precautions.  Individuals should avoid visiting hospitals and clinics to see patients, visiting relatives, crowded markets, and any other exposures and gatherings.  

Eating herbs, such as garlic, rinsing nose, drinking hot water or alcohol, will not help.  Work from home.  But use the described stringent precautionary principles, when going out of the house at the workplace/store, etc.

I hope you are now using ideally, N95 (3M) or another type of effective face masks, routinely.  Contrary to some faulty claims by politicians, this is important to minimize airborne COVID-19 infection.  The use of standard surgical masks when seeing patients; while it protects patients, may not protect the doctors and nurses.  This might provide a false sense of security and could be the reason why so many healthcare persons getting infected with COVID-19.  Despite precautions, in the U.S. and several other countries, over the past two weeks, hundreds of healthcare workers have contracted COVID-19 (e.g., over 160 is affected in Boston, MA, hospital system, alone).  Healthcare workers (all of them) vigorously working to protect you: affecting even one of them with COVID-19 is too many.

Together with handwashing with soap in running (warm) water for 20 seconds, every time returning to the office and home is essential.  The virus efficiently can enter via all mucous membranes, including eyes, nose, mouth (buccal mucosa), gastrointestinal tract (gut), and the genito-anal regions.  So, do NOT touch any of these areas till you thoroughly wash your hands as described above.  Same after going into any restroom/toilet.

COVID-19 has a fatty outer covering it; thus it is sticky; that’s why soap and any detergent works; it erodes the outer fatty covering thus, harming the COVID-19.  Footwear also gathers viruses.  Thus, consider keeping outside footwear, “outside” the house or at least in the porch or garage.  

With reference to clothing: COVID-19 can stay on clothing and any other material (including shipping bags) for up to 10 hours.  A longer period in damp conditions and/or with air conditioning.  Exposure of clothing to direct sunlight (outside the house) would help.

Fruits and vegetables can get easily contaminated in markets, by those carrying the virus, by coughing and touching them.  Pay extra attention and use your commonsense precautions.  Washing all food items, fruits, and vegetables, etc., in soap and water and rinse well, prior to use is helpful.  Vinegar or saltwater that traditionally used to kill bacteria in vegetables will not work against COVID-19, but detergents will.  For sterilization of surfaces, doorknobs, etc., spraying or rubbing diluted hypochlorite solution (bleach) or soap is apparently sufficient. 

The rapid growth of virus:  At the current rate of spread (at 33%; exponential growth phase) the viral load can double every 3-days.  Thus, in the USA, the number of infected people could exceed 10 million COVID-19 positive patients in six-weeks’ time, unless the expected infectious peaks are “flattened” through effective social distancing and above mentioned all precautionary and proactive actions (not merely by curfews).  However, the lack of access to food as a result of continued curfew (a third of the population is starving; it will lead to immune degradation), is likely to make the situation worse.

In addition, keeping the serum 25(OH) D levels in excess of 40 ng/mL (100 nmol/L) will markedly increase the inherent immunity (stimulating multiple immune pathways) in an individual.  Maintaining such a level will reduce the chances of getting any Coronaviral infections and the severity if they get infected.  

This can be achieved by oral supplementation of 50,000 international units (one capsule, once a week; or a collection of a number of capsules to make a total of 50,000 IU) for approximately, 8  to 12-week period; till the threat is over.  Alternatively, 30 to 45 minutes of daily exposure to direct sunlight (can be intermittent) of a “third of the skin surface, between 9.30 AM and mid-day (afternoons are too hot to be out in the sun), would generate an adequate amount of vitamin D to boost immunity.  This simple process applies to all countries and everyone; it costs nothing.

The current trend is that otherwise healthy younger people are now getting the disease: it is no longer exclusively affecting the elderly.  In addition, younger people can be carriers of transmitting the disease.  Consequently, they and any others should not visit elderly or sick people until the crisis is over unless they directly caring them for.  Anyone visiting them must strictly follow the mentioned hygiene and safety procedures, including wearing face masks.

These are suggestions to keep you and your loved ones healthy, and not considered as medical advice.  If you have questions or concerns, please contact your healthcare provider or the local health authority or hospital to obtain medical advice and additional information.

Everyone must take the current threat from COVID-19 very seriously and collectively work together to eliminate the threat, by abiding the above-mentioned public health guidance and local rules. 

Sunil J Wimalawansa (suniljw@hotmail.com)

Professor of Medicine, Endocrinology, & Nutrition, USA

For more information (LinkedIn), a series of articles on COVID-19:

https://www.linkedin.com/in/sunilwimalawansa/detail/recent-activity/

A scientific article on COVID written  on 5th January (in ResearchGate), predicted what will be happening in March:

https://www.researchgate.net/profile/Sunil_Wimalawansa/research

or 

https://www.researchgate.net/publication/340102912_EJBPS-Prof_WImalawansa-COVID-19-March_2020s

A lay summary of the beneficial effects of vitamin D:

https://www.healthline.com/nutrition/vitamin-d-coronavirus

Extensive information on vitamin D and coronaviruses, including COVID-19:

https://vitamindwiki.com